In testicular sperm extraction (TESE), sperm are retrieved directly from the testicular tissue. The procedure may be considered for fertility treatment if no sperm can be detected in the ejaculate (azoospermia), but sperm are produced or can be found in the testes.
The retrieved sperm can then be used for intracytoplasmic sperm injection (ICSI) and cryopreserved if necessary. Whether TESE is advisable depends on the cause of the azoospermia and the preceding examinations.
- What is TESE?
- When is TESE useful?
- TESE treatment procedure in Munich
- TESE or Micro-TESE: What is the difference?
- What are the success rates for TESE and ICSI?
- What happens after a successful TESE?
- Frequently asked questions about testicular sperm extraction
What is TESE?
During TESE, tissue samples are taken from the testis via a minor surgical procedure and subsequently examined for sperm in the laboratory. The procedure is usually performed by specialized urologists or andrologists.
TESE is particularly considered in cases of azoospermia, when no sperm can be detected in the ejaculate despite repeated examinations. A distinction is made between obstructive azoospermia, where the seminal ducts are blocked or absent, and non-obstructive azoospermia (NOA), where sperm production in the testis is impaired.
If sperm are found during TESE, they can be used for fertility treatment via ICSI (intracytoplasmic sperm injection) and, if necessary, frozen for later treatment.
When is TESE useful?
Whether TESE is advisable depends primarily on the cause of the azoospermia.
In obstructive azoospermia, sperm are produced in the testis but cannot reach the ejaculate due to a blockage or missing seminal ducts. Possible causes include:
- a previous vasectomy,
- congenitally absent vas deferens, for example in connection with certain CFTR gene variants,
- other obstructions of the seminal ducts.
In non-obstructive azoospermia, on the other hand, sperm production within the testis itself is severely limited. However, sperm may still be present in individual areas of the testicular tissue. In these cases, Micro-TESE is particularly suitable for sperm retrieval.
The use of testicular sperm is also being scientifically investigated in cases of increased sperm DNA fragmentation. However, TESE based solely on increased DNA fragmentation is not a standard treatment and should only be performed after individual medical consideration.
A careful andrological evaluation is important before TESE. Azoospermia should be confirmed by at least two spermiograms. Depending on the findings, diagnostics also include a physical examination, hormone levels, an ultrasound of the testes, and genetic testing.
TESE treatment procedure in Munich
TESE is performed in cooperation with an experienced urologist or andrologist at a specialized center in Munich. Before the procedure, a comprehensive andrological diagnosis is carried out to clarify the cause and assess which sperm retrieval method is suitable. TESE is usually performed on an outpatient basis.
Before the procedure, the necessary preliminary examinations are carried out and the surgical process is discussed. At our partner facility, TESE is usually performed under a short general anesthetic.
The testicular sheath is carefully opened, and small tissue samples are taken from the testis. Depending on the findings and preliminary diagnosis, samples can be taken from one or both sides. The retrieved testicular tissue is then examined in the laboratory for the presence of sperm.
If sperm are found in the retrieved testicular tissue, they are then cryopreserved in several straws and can be used for later ICSI treatment.
Short-term monitoring is required after the procedure. In the first few days, pain, swelling, or bruising may occur in the testicular area. Physical exertion should be avoided in the following days. Cooling measures can help alleviate discomfort and swelling.
TESE or Micro-TESE: What is the difference?
In Micro-TESE (micro-TESE), the testicular tissue is examined using an operating microscope. This allows for the targeted identification and removal of seminiferous tubules where the probability of sperm presence is higher. At the same time, the amount of testicular tissue removed can be reduced.
The procedure is particularly suitable when sperm production in the testis is severely limited and may only be preserved in individual areas. Current guidelines on male infertility view Micro-TESE as the preferred method for surgical sperm retrieval in non-obstructive azoospermia.
Even after an unsuccessful conventional TESE, Micro-TESE can still find sperm in selected cases. Studies also show evidence of benefits for certain histological findings such as Sertoli-Cell-Only syndrome (SCO). However, successful sperm retrieval cannot be guaranteed even with Micro-TESE.
What are the success rates for TESE and ICSI?
The probability of finding sperm during TESE depends significantly on the underlying cause. In cases of severely limited sperm production, the chances of sperm retrieval can vary significantly and can only be predicted to a limited extent before the procedure.
If sperm are retrieved, they can be used for ICSI treatment. The chances of pregnancy and live birth then depend on various factors – in particular the age and fertility of the female partner as well as other individual circumstances of the couple. Therefore, we discuss the prospects of success for TESE and subsequent ICSI individually as part of the fertility treatment.
What happens after a successful TESE?
If sperm are found during TESE, they can be cryopreserved and stored for later ICSI treatment. During ICSI, a single sperm cell is introduced directly into an egg cell.
Thanks to cryopreservation, sperm retrieval and fertility treatment do not have to take place at the same time. If sufficient suitable sperm are available, the frozen samples can also be used for further treatment attempts if necessary.
We plan further fertility treatment individually based on the available samples and the medical requirements of both partners.
Frequently Asked Questions about TESE
How long does healing take after TESE?
Pain, swelling, or bruising can occur in the first few days after the procedure and usually subside after a few days. It can take about one to two weeks for the wound to heal completely. How long physical rest is required depends on the individual healing process and the procedure performed.
Is TESE painful?
TESE is performed under anesthesia, so no pain is usually felt during the procedure. After the procedure, pain in the testicular area as well as swelling or bruising may occur. The severity of the discomfort varies from person to person. Cooling, physical rest, and pain relief medication if needed can help alleviate the symptoms.
When are the results of the sperm examination available?
You will usually find out whether sperm were found in the retrieved tissue samples on the day of the procedure.
Who bears the costs for testicular sperm extraction?
Whether the costs of TESE are covered by health insurance depends on the individual insurance situation and the medical requirements. Privately insured individuals should clarify cost coverage with their insurance provider before the procedure. Those with statutory insurance should also check with their health insurance fund in advance to see which costs will be covered in their specific case.
What happens if no sperm are found during TESE?
If no sperm are found during TESE, the retrieved samples cannot be used for ICSI. What happens next depends on the cause of the azoospermia, the procedure performed, and the findings to date. In selected cases, further examinations or a repeat surgical sperm retrieval, for example via Micro-TESE, may be considered. Further options should be discussed individually with the treating urologist or andrologist and the fertility center.
How often can TESE be performed?
TESE can generally be repeated. However, whether and when a further procedure is advisable depends on the cause of the azoospermia, the findings to date, and the result of previous sperm retrievals. Since testicular tissue is removed during each procedure and complications such as bruising or changes to the testicular tissue can occur, a repeat TESE should be weighed individually with the treating urologist or andrologist.
